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Medieval coffin birth: A modern medical mystery

In 2010, archeological diggings in Imola, Italy, yielded a sad yet intriguing find: the skeleton of a medieval woman with a hole in her skull and the mysterious the remains of a fetus. Scientists concluded that this was a coffin birth, and that the hole was caused by an ancient procedure called trepanation.

The ancient remains of a mother and her fetus 'born' in the grave might highlight how much we still don't know about the human body.

An unusual postmortem phenomenon recorded throughout history is the inaccurately dubbed "coffin birth."

I say the word "inaccurate" because it suggests that the body of a deceased pregnant person can give birth to the fetus that it carries.

However, that's not the case at all. After death, the cervix cannot dilate to allow the fetus to pass through. So what happens?

Well, as mortician and author Caitlin Doughty explains, the scientific name of this phenomenon is actually "postmortem fetal extrusion" and "can happen 48–72 hours after the death of a pregnant woman."

"As the gas in her abdomen builds up due to decomposition, pressure rises to the point that it presses on the uterus so intensely that the unborn fetus is expelled or partly expelled from the mother's body," she says.

In a study now published in the journal World Neurosurgery, researchers from the Universities of Bologna and Ferrara, both in Italy, analyzed the case of one such coffin birth uncovered by archeologists a few years ago.

This case — dated to the Lombard period (7th–8th century Italy) — concerned the skeleton of an adult woman, probably aged 25–35, and that of her unborn child, "found [...] between the pelvis and the lower limbs of the adult."

The position of the fetus suggested to the study authors — who are Alba Pasini, Vanessa Samantha Manzon, Xabier Gonzalez-Muro, and Emanuela Gualdi-Russo — that it had been expelled from the body after the mother's death, likely in the manner described above.

The researchers also noted that, looking at the size of the fetus's femur, it may have been around 38 weeks into the mother's pregnancy when she died.

What truly intrigued the scientists was that the mother's remains also held another peculiarity: her skull exhibited a mysterious hole.

A precursor to modern neurosurgery

Based on the appearance of the hole in the woman's skull, the researchers concluded that it had been created with "a circular-section metal instrument," which is consistent with the ancient procedure of trepanation.

This skull-drilling practice, which is over 5,000 years old in Europe and even older elsewhere in the world, has baffled archeologists and anthropologists for a long time.

Some researchers have hypothesized that trepanation may have had a ritual purpose and was not at all connected to medical needs. However, a more popular theory — to which the authors of the new study also subscribe — is that it was the precursor to modern-day brain surgery.

Pasini and colleagues explain that trepanation was probably used to treat a wide range of ailments, especially migraines and hypertension-related conditions.

"Trepanation is known to have been applied [...] as a surgical intervention aimed at treating several types of diseases, such as traumatic injuries or neurologic issues, and, in particular, migraines caused by high intracranial pressure or cerebral disturbances related to vascular pathologies."

So what about the case at hand — why would trepanation have been required? It's hard to say, but the researchers hypothesize that the expectant mother may have experienced a complication that still affects many pregnant women today: preeclampsia.

Ongoing risks in pregnancy

Expectant mothers with preeclampsia experience hypertension that "reduces the blood supply to the fetus," putting its health in danger. This condition may develop into eclampsia, in which pregnant women may experience seizures or even go into a coma.

There is no treatment for preeclampsia, and the only way to avoid it, according to the National Institutes of Health (NIH), is to deliver the fetus as soon as possible if the mother has a known risk for developing this condition.

Estimates suggest that around 3.4 percent of pregnancies in the United States may be affected by preeclampsia, and worldwide, it may account for 10–20 percent of all maternal deaths.

Considering this situation, we might say that whoever performed the trepanation on the woman from medieval Italy may have tried their best to save the future mother and child at a time when maternal deaths were a common occurrence.

"We hypothesize," say the study authors, "that the woman could have developed a labor-related complication, which indicated the surgical intervention."

However, they add, "[S]till it is not possible to know whether the death [of the woman] incurred because of a labor complication or the [trepanation]."

Although both coffin births and the ancient process of trepanation are still very much surrounded by mystery, such archeological finds take us one step closer to understanding the evolution of medical procedure.

Most importantly, perhaps, they keep reminding us just how far medicine has come, but also how far we still need to go to ensure the health and safety of generations present and future.

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